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Computed tomography (CT) arthrography of the shoulder is an imaging modality of great diagnostic accuracy with regard to glenohumeral instability and in particular labral lesions. Interpretation of the scans is made difficult by the frequent occurrence of normal anatomic variants and the complexity of injuries to the bone and soft tissues. We selected a continuous sample of 50 CT arthrograms of the shoulder and they were reported by two consultant musculoskeletal radiologists. The results were collated and analysed for the level of agreement. Hill-Sachs showed Kappa (K) statistic to be 0.37 (fair agreement), soft tissue Bankart 0.32 (fair agreement), bony Bankart 0.61 (substantial agreement), anterior capsular laxity 0.41 (moderate agreement) and glenohumeral osteoarthritis 0.20 (slight agreement). All the results were significant with a p value of <0.05. Nine (18%) of the 50 scans were in complete agreement. The results demonstrate that there can be considerable interobserver variation (IOV) in the reports of a CT arthrogram of a shoulder. They highlight the potential difficulties in reporting such images and suggests ways in which the report could be more focussed to provide a clinically reliable report and one which matches the surgical findings accurately., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Staphylococcus aureus pathogenicity islands (SaPIs) are mobile elements that are induced by a helper bacteriophage to excise and replicate and to be encapsidated in phage-like particles smaller than those of the helper, leading to high-frequency transfer. SaPI mobilization is helper phage specific; only certain SaPIs can be mobilized by a particular helper phage. Staphylococcal phage 80α can mobilize every SaPI tested thus far, including SaPI1, SaPI2 and SaPIbov1. Phage 80, on the other hand, cannot mobilize SaPI1, and ϕ11 mobilizes only SaPIbov1. In order to better understand the relationship between SaPIs and their helper phages, the genomes of phages 80 and 80α were sequenced, compared with other staphylococcal phage genomes, and analyzed for unique features that may be involved in SaPI mobilization., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Aim: To assess selectively trained radiographers and consultant radiologists reporting plain radiographs for the Accident and Emergency Department (A&E) and general practitioners (GPs) within a typical hospital setting., Methods: Two radiographers, a group of eight consultant radiologists, and a reference standard radiologist independently reported under controlled conditions a retrospectively selected, random, stratified sample of 400 A&E and 400 GP plain radiographs. An independent consultant radiologist judged whether the radiographer and radiologist reports agreed with the reference standard report. Clinicians then assessed whether radiographer and radiologist incorrect reports affected confidence in their diagnosis and treatment plans, and patient outcome., Results: For A&E and GP plain radiographs, respectively, there was a 1% (95% confidence interval (CI) -2 to 5) and 4% (95% CI -1 to 8) difference in reporting accuracy between the two professional groups. For both A&E and GP cases there was an 8% difference in the clinicians' confidence in their diagnosis based on radiographer or radiologist incorrect reports. For A&E and GP cases, respectively, there was a 2% and 8% difference in the clinicians' confidence in their management plans based on radiographer or radiologist incorrect reports. For A&E and GP cases, respectively, there was a 1% and 11% difference in effect on patient outcome of radiographer or radiologist incorrect reports., Conclusion: There is the potential to extend the reporting role of selectively trained radiographers to include plain radiographs for all A&E and GP patients. Further research conducted during clinical practice at a number of sites is recommended.

ki ctes over whether molecular sequence data should be partitioned for phylogenetic analysis often confound two types of heterogeneity among partitions. We distinguish historical heterogeneity (i.e., different partitions have different evolutionary relationships) from dynamic heterogeneity (i.e., different partitions show different patterns of sequence evolution) and explore the impact of the latter on phylogenetic accuracy and precision with a two-gene, mitochondrial data set for cranes. The well-established phylogeny of cranes allows us to contrast tree-based estimates of relevant parameter values with estimates based on pairwise comparisons and to ascertain the effects of incorporating different amounts of process information into phylogenetic estimates. We show that codon positions in the cytochrome b and NADH dehydrogenase subunit 6 genes are dynamically heterogenous under both Poisson and invariable-sites + gamma-rates versions of the F84 model and that heterogeneity includes variation in base composition and transition bias as well as substitution rate. Estimates of transition-bias and relative-rate parameters from pairwise sequence comparisons were comparable to those obtained as tree-based maximum likelihood estimates. Neither rate-category nor mixed-model partitioning strategies resulted in a loss of phylogenetic precision relative to unpartitioned analyses. We suggest that weighted-average distances provide a computationally feasible alternative to direct maximum likelihood estimates of phylogeny for mixed-model analyses of large, dynamically heterogenous data sets., (Copyright 1999 Academic Press.)

Purpose: Our goal was to evaluate use of topical (4 percent) formalin in management of radiation-induced hemorrhagic proctitis, refractory to other methods of treatment. Specifically, we wished to determine its safety, ability to stop bleeding, and complications associated with therapy., Methods: Sixteen patients with radiation-induced hemorrhagic proctitis were treated with topical (4 percent) formalin. All had been previously treated with conservative regimens such as cautery, topical steroids, or laser, but these had failed. Five-hundred milliliters (ml) of a 4 percent formalin solution was instilled into the rectum in 50-ml aliquots. Each aliquot was kept in contact with rectal mucosa for approximately 30 seconds. Treatments were performed under local anesthesia in nine patients, sedation only in four, spinal in two, and general in one patient., Results: In 12 patients, bleeding stopped after a single formalin instillation; in 3, bleeding was considerably reduced but continued sporadically. One patient required three treatments before bleeding stopped. Four patients developed postoperative anal pain, of which one also had significant tenesmus and reduced capacity. Of these four patients, only two had significant anal pain and fissures that lasted longer than one month., Conclusions: Topical (4 percent) formalin is safe and effective in treatment of radiation-induced hemorrhagic proctitis. A single treatment will stop bleeding in 75 percent of patients.

Porcelain veneers are an esthetic, relatively conservative restoration used to cover the facial surface of the teeth. Following proper guidelines, the practitioner can achieve successful results as a matter of routine. This article reviews the most current literature published on this subject to bring practitioners up to date on clinical methods and materials used for porcelain veneers.

Objective: To determine intergroup and intragroup consensus for interdisciplinary perceptions of dietitians' legal responsibility for lethal dietary prescription errors., Design: Survey research was conducted by a mail questionnaire containing four hypothetical cases in which the dietitian provides a lethal amount of dietary potassium for an anephric patient., Setting: Of the 90 New York State end-stage renal disease facilities contacted, 64 returned one or more questionnaires., Subjects/samples: Usable questionnaires were tabulated from 51 registered dietitians, 39 registered head nurses, and 43 physician-medical directors., Measures: Consensus was recognized when 60% or more of the responses occurred in one extreme collapsed and dichotomized category of "yes" or "no" regarding the dietitian's legal responsibility., Statistical Analyses Performed: Intergroup and intragroup consensus levels were compared by frequency, mean, standard deviation, and Scheffe test of differences., Results: The triad groups met varying levels of consensus on all four scenarios, with dissenting opinions by nurses on two scenarios. The dietitians and the physician-medical directors had mirror-image perceptions that the dietitian was not legally accountable for two cases of following foreseeably lethal dietary prescriptions "as written." Eight dietitians viewed the dietitian as legally nonculpable for causing a patient's death because of the dietitian's sole incompetence or carelessness in making a serious calculation error. Nurses met the highest levels of agreement and perceived the dietitian to be legally accountable for all four cases. The nurses, in contrast to the dietitians and physician-medical directors, held opinions of dietitian legal responsibility as consistent with the standard of care expectations of prudent health care professionals defined by professional malpractice jurisprudence., Applications/conclusions: The data indicate that to protect both the patient and the professional, there is a notable need for greater understanding dietetics jurisprudence.

This review examines various studies showing the relation between religiosity (religious beliefs and/or practices) and health. It also includes church attendance and its relation to drug use. The role of the church in health promotion is discussed, with examples of church intervention model programs. Several attempts have been made to measure religiosity and religious commitment, but as yet little has been done to identify specific dimensions of religion as they relate to health behaviors. Even though the literature indicates that religion is generally associated with health behaviors, health status, and longevity, further research on the specifics of this relationship is needed.

Both exfoliation syndrome and pigmentary dispersion syndrome can lead to secondary glaucoma. We treated five patients who had pigmentary dispersion and who subsequently developed exfoliation. In one patient who had bilateral pigment dispersion syndrome, the presence of exfoliation increased the difficulty of controlling intraocular pressure in the affected eye. In a monocular patient, exfoliation and pigmentary dispersion were concurrently present with characteristic defects of both pigmentary dispersion and exfoliation as seen by transillumination defects of the iris. A third patient had bilateral pigmentary dispersion and uncontrollable intraocular pressure in an eye with exfoliation. Despite argon laser trabeculoplasty, the pressure remained uncontrolled. Another patient had a filtering operation in the left eye, with gradually increasing intraocular pressure in the right eye. Exfoliation material complicated the pressure control in the unoperated on eye. Another patient had an eight-year history of glaucoma in the left eye for which filtering surgery was performed. Exfoliation was present in both eyes with controlled pressure in the filtered eye but uncontrolled pressure in the nonfiltered eye.

Elevated Factor VIII-von Willebrand factor antigen levels are associated with vascular endothelial injury in several disorders, including scleroderma, Raynaud's phenomenon, polymyalgia rheumatica, and temporal arteritis. Eight patients with serpiginous choroidopathy were evaluated with the use of quantitative immunoelectrophoresis for Factor VIII-von Willebrand factor antigen. The serpiginous choroidopathy patients had a mean Factor VIII-von Willebrand factor activity of 226 +/- 47.3%, whereas a disease-free, age- and sex-matched control group had a mean activity of 107 +/- 28%. These findings are statistically significant (P greater than 0.005) and suggest that in some patients, serpiginous choroidopathy represents an occlusive vascular phenomenon that involves the choroidal circulation.

Activity in the flight muscles and jump muscles in Drosophila can be stimulated by excitation of a pair of giant fibres that enter the thoracic ganglion from the brain. Contrary to previous descriptions, these giant fibres are not themselves motor axons. Each giant fibre contacts both a large motor axon and an interneuron. The motor axon innervates the ipsilateral tergotrochanteral (jump) muscle. The interneuron synapses in turn with the motor neurons that innervate the contralateral dorsal longitudinal flight muscle. The output synapses of this interneuron occur directly onto the motor axons within a peripheral nerve. The unusual peripheral location for these interneuron synapses suggests that the interneuron may function to speed up activation of the motor axons by bypassing integration within the motor neurons' dendritic trees. The synapses are typical dipteran chemical synapses, with occasional reciprocal contacts from the motor axons back onto the interneuron. The interneuron-motor axon synapses may be especially useful for morphological studies of identified synaptic contacts because their peripheral location makes them extremely easy to locate and identify.

Identified neurons in the stomatogastric ganglion of the lobster were examined and reconstructed by serial section electron microscopy. Each motor neuron consists of a soma, a primary process leading directly from the soma to the motor axon which leaves the ganglion, and a group of secondary processes which branch from the primary process and ramify within the neuropil. Synapses are found only on small processes in the synaptic neuropil, never on the primary processes or on larger secondary processes in the coarse neuropil. Nearly every secondary process of every neuron examined makes both pre- and postsynaptic contacts. Hence these neurons are not polarized into distinct pre- and postsynaptic regions but have both input and output distributed over each of the secondary processes in the neuropil. The conncetion between a specific pair of neurons is also distributed over several branches of both the pre- and the postsynaptic neurons. The restriction of synapses to the more distal portions of the secondary processes suggests that no single contact or localized group of contacts can exert an overrriding influence on the neuron by virtue of an especially advantageous position. The close proximity of input and output on most secondary processes suggests that synaptic input may be capable of directly influencing output without the intervention of action potentials. The distribution of specific synapses over several branches of both pre- and postsynaptic neurons suggests that each neuron functions as a whole without differentiation into specialized branches.

Embryonal rhabdomyosarcoma of the prostate is typically a rare mesenchymal tumor of young boys, presenting with obstructive urinary symptoms or an abdominal mass. The origin is probably in undifferentiated mesenchymal cells that persist into adult life. Histologically, the tumor cells resemble normal muscle development in a 7 to 10-week fetus. Treatment is combined radical surgery and chemotherapy, and usually radiotherapy as well. The prognosis is extremely poor in all patients. Our case is added to the few in the literature in which this disease occurred in a man more than 50 years old.

With computer reformatting techniques, it is possible to project any lesion into its proper position with respect to the reformatted midsagittal computed tomography (CT) plane, the reformatted biparietal CT plane, or any other useful reference plane. The calvarial contour depicted on the reformatted midsagittal CT image is exactly comparable to the calvarial contour seen on a true lateral skull radiograph, and the calvarial contour depicted on the reformatted biparietal CT image is exactly comparable to the biparietal calvarial contour seen on the standard frontal skull radiograph. Using simple geometric proportions, therefore, it is easy to transfer the projection of a lesion from the reformatted images onto true lateral and frontal skull radiographs to provide neurosurgeons and radiotherapists with frontal and lateral pictures of the lesion and the skull suitable for planning surgical incisions and radiation portals.

"Fish-mouth" ureteroneocystostomy was successful in a patient with bilateral ureteral obstruction secondary to locally invasive adenocarcinoma of the prostate. The complications of permanent intubation are avoided and renal function is restored.

The Continaid pelvic floor stimulating electrode is useful in reception of electromyographic signals, a use for which the device was not originally conceived. I believe there is money to be saved and some clinical problems can be avoided when this plug is substituted for some others now in clinical use.

The peritrophic membrane of Drosophila melanogaster consists of four layers, each associated with a specific region of the folded epithelial lining of the cardia. The epithelium is adapted to produce this multilaminar peritrophic membrane by bringing together several regions of foregut and midgut, each characterized by a distinctively differentiated cell type. The very thin, electron-dense inner layer of the peritrophic membrane originates adjacent to the cuticular surface of the stomadeal valve and so appears to require some contribution by the underlying foregut cells. These foregut cells are characterized by dense concentrations of glycogen, extensive arrays of smooth endoplasmic reticulum, and pleated apical plasma membranes. The second and thickest layer of the peritrophic membrane coalesces from amorphous, periodic acid-Schiff-positive material between the microvilli of midgut cells in the neck of the valve. The third layer of the peritrophic membrane is composed of fine electron-dense granules associated with the tall midgut cells of the outer cardia wall. These columnar cells are characterized by cytoplasm filled with extensive rough endoplasmic reticulum and numerous Golgi bodies and by an apical projection filled with secretory vesicles and covered by microvilli. The fourth, outer layer of the peritrophic membrane originates over the brush border of the cuboidal midgut cells, which connect the cardia with the ventriculus.

With a high resolution modification of a translate--rotate body scanner (EMI CT5005), radiologists may now demonstrate the epidural fat, thecal sac, and axillary pouches of the lower thoracic, lumbar, and sacral spinal canal without using contrast agents. Preliminary results with a newer rotary motion scanner (EMI CT7070) suggest that this scanner achieves sequally good delineation of intracanalicular anatomy.

The stomatogastric ganglion of the lobster consists of about thiry neurons, mainly large monopolar cells, which have been well characterized physiologically. This paper presents an anatomical description of this ganglion, emphasizing synaptic connections in the neuropil. The neuron cell bodies are located on the dorsal surface of the ganglion. They send processes into the underlying neuropil mass. The neuropil is differentiated into two regions: a core of coarse neuropil consists of large heavily ensheathed processes; a surrounding region of fine-textured synaptic neuropil consists of smaller unsheather processes. Synapses are found only in synaptic neuropil, not in the core of coarse neuropil. Synaptic contacts, about one million in the entire neuropil, are easily recognized by a set of criteria including presynaptic vesicles and pre- and postsynaptic membrane specializations. Most synaptic contacts invole at least three neural processes, usually one pre- and two postsynaptic elements. Synapses are clustered onto irregular swellings or varicosities on neural processes. These varicosities make both pre- and postsynaptic contacts. Three differenty types of presynaptic profile are recognized. Pyloric dilator, ventricular dilator and lateral posterior gastric neurons belong to type A with clear irregular synaptic vesicles. Lateral pyloric, pyloric, anterior median and dorsal gastric neurons belong to type B with larger clear round vesicles. Many unidentified fibres, presumably stomatogastric nerve afferents, blong to type C with both small clear irregular vesicles and also large dense-core vesicles. The synaptic vesicle types are tentatively correlated with neurotransmitter: type A with acetylcholine, type B with an unknown transmitter, possibly glutamate, and type C with dopamine. The distribution of synaptic contacts on the processes of identified neurons reconstructed from serial section is presented in the following paper.

Thoracic axons occurring in Musca and Sarcophaga are similar to those previously reported in the giant fiber pathway of Drosophila. Serial section reconstruction of both species has shown that the cervical giant fiber descending from the brain into the thoracic ganglion and the thoracic motor axon innervating the tergotrochanteral muscle follow courses matching those of similar axons in Drosophila. Likewise in both Musca and Sarcophaga a thoracic axon establishes axoaxonal synapses onto dorsal longitudinal muscle motor neurons. This axon is similar in both course and synaptic configuration to the peripherally synapsing interneuron in Drosophila. Although these similarities suggest that the three axon pairs are homologous in all three fly species, Several differences are also observed. Thus this system of identified axons may be a useful model for investigating phylogenetic variation in specific neuronal form and connectivity.

In each of 30 dipteran species, representing 13 acalyptrate and 7 calyptrate families, the cardia is formed from specialized cells at the junction between foregut and midgut. Foregut epithelium forms the stomodeal valve; midgut epithelium envelops the valve to form the cardia's outer wall. Cytological characteristics within these epithelia differ from region to region and from species to species. Since the cardia secretes the peritrophic membrane, cardias with diverse patterns of cellular differentiation may be expected to produce peritrophic membranes with similarly diverse properties. Close relatives often share more details of cardia structure than do distantly related taxa. Within the monophyletic Calyptratae, a common pattern of cellular differentiation includes three distinct zones of columnar midgut cells enclosing a flanged stomodeal valve. Among species in the paraphyletic Acalyptratae, midgut typically includes a single zone of tall columnar cells, while the valve may be spheroidal, cylindrical, conical, or flanged. The correlation of phylogenetic distance with divergence in cardia organization implies a strong influence of ancestry upon current structure, regardless of current diet. However, at least some of the observed diversity in cardia structure is associated with dietary divergence. Calyptrate flies with derived blood-feeding behavior display cellular differentiation that is simplified from that seen in calyptrate relatives with less specialized feeding habits. This evolutionary modification suggests that cardia organization and hence peritrophic membrane structure can adapt to dietary changes, with possible significance for the spatial organization of digestive processes and interactions with ingested microorganisms.

The needle, anal and catheter methods of performing simultaneous cystometry and pelvic floor electromyography were compared in 29 patients. Urethral sphincter electromyographic recordings consistently were satisfactory with a needle electrode, whereas the catheter surface electrode caused recording artifacts and was fragile. Anal sphincter electromyography was more reliable with a needle electrode than with an anal surface electrode.